Riverside study supports IUD use by teens

Only 4.5 percent of women under the age of 20 use long-acting reversible contraception, despite growing evidence of its safety and effectiveness.

"Many providers have not been counseling adolescents about the use of an IUD (intrauterine device) for contraception because of an unwarranted concern of an increased risk of infection in this patient population," said Dale W. Stovall, an OB-GYN with Riverside Medical Group.

Stovall was one of the principal investigators in a national study led by Riverside Health System and conducted with Georgetown University School of Medicine. The results were published recently in the journal Obstetrics & Gynecology.

Among contraceptive methods in older women — in their 20s and 30s — IUDs have one of the highest rates of satisfaction and effectiveness, according to the study's authors. The lack of data regarding their use by adolescents led Stovall and his colleague Joelle Aoun M.D. to develop the study.

The study involved chart reviews over three years of more than 2,500 patients, aged 13 to 35; its results showed that safety and effectiveness were not affected either by the age of the user or whether they had previously given birth.

The Food and Drug Administration currently approves two styles of the T-shaped implant, the ParaGard and Mirena. The ParaGard, a non-hormonal type that contains copper, is considered effective for up to 10 years. The Mirena, which contains slow-release progesterone and is also prescribed to reduce bleeding, is effective for up to five years, while its smaller counterpart, the Skyla, lasts for three years. The initial cost of placing an IUD ($500 to $1,000) only makes it cost-effective for longer-term use, said Stovall.

The only difference the study found between teens and women up to age 35 was in the discontinuation rate; after the first year, the younger demographic wanted the device removed at a higher rate. "It wasn't clear to us in the charts that adolescents were properly counseled; they may have stopped sooner because of pain and bleeding, which may not have been related to the IUD," said Stovall. The researchers believed that the teens would benefit from more counseling.

Their favored contraceptive methods — withdrawal, condoms and oral contraceptive pills — are all associated with relatively high failure rates and low rates of continuation, which contribute to teen pregnancy rates.

"We used to think that IUDs were not good for people who hadn't had a baby. But it's really the opposite," she said. "The five-year or 10-year devices offer reliable protection in a way that having to remember a daily pill does not."

The Riverside study's findings led the authors to recommend the use of IUDs by women of all ages, and without regard to whether they had previously given birth.